0000883984-11-000097.txt : 20111130 0000883984-11-000097.hdr.sgml : 20111130 20111130195631 ACCESSION NUMBER: 0000883984-11-000097 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111130 FILED AS OF DATE: 20111130 DATE AS OF CHANGE: 20111130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COSTELLO RICHARD A CENTRAL INDEX KEY: 0001073401 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34634 FILM NUMBER: 111235247 MAIL ADDRESS: STREET 1: C/O ICU MEDICAL INC STREET 2: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ICU MEDICAL INC/DE CENTRAL INDEX KEY: 0000883984 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 330022692 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763-6212 BUSINESS PHONE: 949-366-2183 MAIL ADDRESS: STREET 1: 951 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92763-6212 4 1 edgardoc.xml PRIMARY DOCUMENT X0304 4 2011-11-30 0 0000883984 ICU MEDICAL INC/DE ICUI 0001073401 COSTELLO RICHARD A 951 CALLE AMANECER SAN CLEMENTE CA 92673 0 1 0 0 Vice President Sales Common Stock 2011-11-30 2011-11-30 4 X 0 5000.0 31.195 A 5000.0 D Common Stock 2011-11-30 2011-11-30 4 S 0 5000.0 43.4729 D 0.0 D Non-Qualified Stock Option (right to buy) 31.195 2011-11-30 4 X 0 5000.0 D 2004-10-16 2015-04-16 Common Stock 5000.0 0.0 D The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $43.53 to $43.38, inclusive. The reporting person undertakes to provide ICU Medical, Inc., any security holder of ICU Medical, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this Form 4. Transaction is the exercise of a derivative security; see Column 2. By: Lynn DeMartini For: Richard A. Costello 2011-11-30